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Women's Health

Care & Treatment

Treatment During Perimenopause

The severity of perimenopausal symptoms can vary significantly from one woman to another. Some women have very mild symptoms during perimenopause. But other women have severe, even debilitating, symptoms.

The good news is that there are a range of strategies and treatments that can help. For instance, if you suffer from vaginal dryness, an over-the-counter, water-based lubricant such as K-Y Jelly can help. Not douching—which is drying—may help, too. So can remaining sexually active because that will also help prevent thinning and inflammation of the vaginal walls.

If you have hot flashes, keep your home as cool as possible; wear breathable fabrics such as cotton and silk; and drink cold beverages to help bring relief. Also consider limiting the amount of alcohol you drink; finding ways to better manage or reduce stress in your life; and quitting smoking as these may help you feel better.

If you try these strategies and your symptoms don’t improve, however, there are other options, including prescription medications. Certain antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and selective serotonin-norephinephrine inhibitors (SSNRIs) relieve hot flashes and night sweats for many women. Some medications prescribed for osteoporosis, high blood pressure, and seizures also have a good track record for relieving hot flashes and night sweats. Topical estrogen therapy (inserting creams, rings, or tablets containing low doses of estrogen into the vagina) may help treat vaginal dryness, ease discomfort during sex, and lower risks of urinary problems.   

Hormone Therapy

Hormone therapy may be another option. This type of therapy is particularly effective in easing perimenopausal symptoms, including hot flashes, night sweats, and vaginal dryness. Research finds that hormone therapy can also lower your risks of heart disease and osteoporosis, but only while you continue the therapy. Hormone therapy is available in pill form and in patches that stick to your skin. The pills and patches may include either estrogen alone, or estrogen and another female hormone called progesterone. Women who have had a hysterectomy (surgery to remove the uterus)are usually prescribed estrogen-only pills or patches. Those who haven’t had a hysterectomy are usually prescribed combination pills or patches containing both hormones. This is because giving estrogen to a woman who still has her uterus will increase her risk of cancer of the endometrium (the lining of the uterus). Progesterone, however, may increase woman’s risk of breast cancer. So if your risk of breast cancer is already significant, for example, because breast cancer runs in your family—your healthcare professional may recommend estrogen-only hormone therapy, along with yearly checks for possible signs of endometrial cancer.

When deciding whether to try hormone therapy, you need to weigh the benefits and risks of therapy. Your healthcare professional can help you do this. The benefits and risks vary from woman to woman because they vary with several factors. These include:  

• your age
• if you’ve already reached menopause
• your current health
• if you’ve had certain health problems such as cancer
• if certain health problems run in your family.

Whether you’re perimenopausal or postmenopausal, appears to be a key factor in determining whether the benefits of hormone therapy are likely to outweigh your risks. Recent findings from the Women's Health Initiative (a major study of the benefits and risks of HT) suggest that women who use this therapy well after menopause run increased risks of heart attacks, strokes, blood clots and breast cancer. The more years that have elapsed since menopause, the higher the risks, findings suggest.

Even if you’ve just begun perimenopause, however, hormone therapy is not recommended if you have certain health problems. These include breast cancer, heart disease, advanced endometrial cancer, vaginal bleeding due to unknown causes, blood clots, strokes or mini strokes.  

The bottom line: You and your healthcare professional should consider your current health, medical history, and family health history, as well as whether and how long ago you reached menopause, before deciding whether hormone is for you.  

Updated: March 2012
Posted:  March 2012